Lean in Saskatchewan

I couldn’t do it. Could you?

I couldn’t do it. I couldn’t ask the nurses and doctor who looked after my daughter to wash their hands.

Last week I took my daughter to our local pediatrics emergency room. My daughter is tough, so when she had tears trickling down her cheeks after falling down a couple of stairs, I was pretty sure she had broken her arm.

She received great care during our brief time at the hospital. We loved the new registration process that was done by her nurse and registration clerk at the same time. My daughter was asked about her pain and offered pain medications by every nurse who met her. It was a very busy evening and our wait was not all that bad. I’m confident that everyone who helped my daughter was caring, competent, and eager to help.

But I didn’t see anyone wash their hands before or after they cared for my daughter. And I couldn’t get out the words “Excuse me, would you please wash your hands for us?” I’ve thought long and hard about why I didn’t say anything.

I was worried about making the doctor and nurses feel uncomfortable. I knew my daughter’s care wouldn’t be compromised if I upset the doctor and nurses. I just didn’t want any awkward feelings. I rationalized this by reminding myself that my daughter is healthy, with an extremely robust immune system. I also know she herself is an excellent hand washer. But that’s just me trying to make myself feel better. I should have said something.

Hand hygiene is perhaps the single most important thing that we can do to help keep our patients safe. By consistently washing our hands before and after every patient interaction, we can decrease — even prevent — the transmission of hospital acquired infections. But healthcare worker compliance with hand hygiene has also shown itself to be notoriously difficult to achieve.

Personally I’m a bit of a nut when it comes to hand hygiene. I feel very uncomfortable during that short period of time between finishing with a patient and walking over to a gel dispenser. Out of curiosity, today I kept track of the number of times I either washed my hands or used an alcohol-based gel while working 9 hours in the ICU: 92! I’m even part of a Saskatoon Health Region YouTube video talking about how important it is that physicians practice excellent hand hygiene.

Patient empowerment is a key component of most successful hand hygiene campaigns. My personal experience showed me how difficult patient empowerment might actually be. Patient and family education will be key. But so will changing the culture in our system, so that doctors and nurses invite and remind patients to advocate for themselves. We must make it easier for our patients to speak up and help protect themselves. Some hospitals have been able to empower patients to remind their healthcare workers to wash their hands. Others have not.

Next time I will be more brave. I also will continue to encourage the families of my patients to speak up if they have any worry that we might have missed hand hygiene, a critical step in providing safe care.

Have you as a patient ever asked a healthcare worker to wash their hands? What did it feel like and what was the response? Have you, as a healthcare worker, ever been asked to wash your hands by a patient? How did it feel? What did you learn?

What did you think of this post? Click below and let us know.

About Dr. Susan Shaw

Chair, Health Quality Council.

Department Head, Adult Critical Care, Saskatoon Health Region.

Susan is Physician Co-lead for the Saskatchewan Surgical Initiative and an Assistant Professor with the College of Medicine’s Department of Anesthesiology, Perioperative Medicine and Pain Management at the University of Saskatchewan. She returned home to Saskatchewan to practice critical care medicine and anesthesiology in Saskatoon after completing fellowship training at Stanford University Medical Center in California.

About Better

Technology is the way of the future in medicine and I think this would help everybody – physicians as well as patients!

Dr. Rossouw, Physician, Regina Qu'Appelle

I was encouraged by the electronic concept of providing documentation in the Emergency Department. As a patient advisor, it was a positive experience to work with actual patients to receive patient input and opinions into this process.

Bev Greenfield, patient, Regina Qu'Appelle

This will save us a lot of time spent searching for equipment so that we can focus more on patient care.

Amanda Dela Cruz , LPN, Regina Qu'Appelle

Ordering supplies is logical and simplified…. (This project) will prevent an abundance of supplies that are not used, (resulting in) cost savings.

Shawn Duddridge , RN, Prairie North

I was excited to be part of a much needed project. It was great to see Emergency Department physician engagement. This will be a great improvement for patient care!

Shona Lafreniere Health Records Staff, Regina Qu'Appelle

Looking forward to saving steps and freeing up some time for Resident interaction. Good to be able to document interactions

Connie Redekop, CCA, Cypress

The passion targeted to quality care for our patients demonstrated during this RPIW will lead to great results.

Kevin Kozan, patient, Regina Qu'Appelle

The addition of a mobile stock/linen cart for the CCA’s with adequate stock greatly reduces lost time and steps. Go Team! By adding this time back to their day it can be used for prompt documentation and quality interactions with Residents.

Seccora Mazur, CCA, Cypress

With now having questions to ask, there can be more one on one interactions. With the introduction of the white boards in the room, I can see what is going on as a family member and also see what they need.

Cathy Nault, patient, Cypress

45 Responses to “I couldn’t do it. Could you?”

Great conversation! Semmelweis would be rolling his eyes…”Are they STILL talking about doing that?? ” I love the different ideas – the buttons, the contract cards, the innovations to personal foam dispensers – this is a complex problem that requires complex solutions. My favorite is the video idea – and it is likely true that we only need equipment that appears to be a live camera, to elicit the ‘bystander effect’. I believe this has been proven in Australia with speed detecting cameras…if you think someone is watching your compliance/behaviour improves. Martin Mackery – author of ‘Accountable’ was a keynote speaker at our most recent Quality Conference and he discussed this stratedgy at length. I ordered a copy of his book at our hospital library and know I am going to love it! I too have had an experience where an ophthalmologist examined my mother’s eye without washing his hands – I did not speak up…she is cognitively challenged…but is of the era that would not challenge even if given permission. As care providers it is OUR responsibility to keep our patients safe and while I agree that patients need to be part of their care team – we should be cautious of off-loading the burden to them, asking the to police/monitor the safe delivery of care. A patient once commented that if she smelled cigarette smoke on a care giver her thoughts were “if you care so little about yourself – how can I believe you care about me?” So if patients need to remind us to wash our hands when they can see and monitor our ways – what are we doing when they are asleep?
The rest of the Safetly Checklist I hope.

Thanks for posting. Not only did I not ask after the ER doctor shook my hand but never did at my monthly visits to a walk-in clinic for allergy shots where the doctor always shook my hand.
If we as people in the health industry and champions for quality can’t do it, is it realistic for us to expect seniors, the vulnerable and immigrants to be braver than us?

Thanks for sharing your story Susan. I have found myself in a similar but different predicament. Mine was about stopping the line – As a family member, I saw a problem with my mother-in-law’s care and expressed my concerns. What made me really pause was being told by a healthcare provider it wasn’t my place to question the doctor’s order. While I still tried to talk to others, I was not as confident as when I first started to question.

I know it is my place to question because I am a quality improvement consultant – but it isn’t always that easy. Now I often think if it was that hard for me, imagine what it is like for all the patients and families who don’t work in the system.

I ran into the same concern with a doctor at a Mediclinic. I had a bad chest infection. The Isagel was hanging outside the door and I did not hear any pumping of the container. There was a sink in the room but he did not use it before or after. I hear him go into the next room as soon as he left mine. Guess they don’t practice what they preach.

I work in health care in a city in the southeast of the province. For the past year we have been working on increasing the comfort level of patients and staff so they feel empowered to remind providers to wash their hands. We are measuring the response on a quarterly basis – starting with less that 33% of staff and patients being comfortable with asking the question “did you wash your hands” We did see that over 90% of providers said they won’t not be upset by being reminded. (wonder if that is true?) . We have been slowly working at changing the culture – colourful posters of pictures of all types of staff with captions (Feel Free to Remind Me to wash my hands). Staff during the admission process are asking patients to please let them know if they don’t perform hand hygiene. Nursing staff are instructed through standard processes to perform hand hygiene “in front’ of the patient. The housekeeping staff have a ‘cue’ word to remind each other. We noticed that not all written procedures include hand hygiene at moments of care – we need to always state when to do hand hygiene and not assume that people will just know. The physicians tell us they are ok if we remind them (however, comfort level with doctors is lower than other care providers). At our September survey we have increased to 46% of patients and staff being comfortable – but we are striving for 85% by March 2014. Changing the culture so we are not defensive and all are comfortable is a journey that we think is important to travel – the goal is to get to “stop the line” ..so a housekeeper who notices a physician not do hand hygiene is comfortable stopping the line. The goal would be that patients will witness hand hygiene and there never be a need to have to remind those who care for them.

Even as a seasoned healthcare professional, I find it difficult to speak up and ask a nurse/physician if they had washed their hands prior to providing care to my loved one. When I did ask a nurse if she had washed her hands, I was greeted with a look that said to me I had been labled a “difficult family member”. We don’t ask to be critical, we ask to be safe and to ensure the safety of our loved one. It would have been nice if the healthcare professional had responded with a “Thanks for asking” and then responded accordingly as to whether they had washed their hands/would be doing so…and Thanks for reminding me! Thanks for sharing this story, I plan to share it with co-workers to keep the discussion going.

Hi Sharon and thanks for adding your experience and thoughts to this conversation. I think many people worry about being labeled as “difficult” should we apeak up or ask questions of our care providers. We all want to know we are safe.

What I learned from my experience is that it is the responsibility of the care provider and the healthcare system to do the right thing every time for every patient without expecting patients to be the inspectors of our work. This doesn’t mean we can’t partner with patients. We just have a lot of work to do to flatten the hierarchy and make not only the care safe but also make it safe for patients and families to speak up and ask whenever they want.

Great post. I was in the Emergency Department at RUH the other day and noticed a sing on one of the doors – Hand Hygiene Audit – 68% – How are we doing? It was dated July 2012. Given it was 68% and we are now in November and no further audit appears to have occurred, I think the question is answered – there is still a lot of room for improvement!

We have gone t0 the same doctor for nearly 30 years. He has a lab in his office where they draw blood during physical exams. After seeing programs on TV about the importance of good hand hygiene, at his last appointment my husband asked the technician to put on gloves before she drew blood. She acted quite surprised about the request and said “she wasn’t worried” about it. My husband said he was worried as she may have touched another patient’s blood. She did put on gloves, but didn’t wash her hands first. He felt very uncomfortable about the situation and feels she thought he was being “difficult”. We didn’t, but should have, contacted the doctor about it.

I am thoroughly enjoying this dialogue. Susan- this has been the one element of my recent care experience that has haunted me. . . I couldn’t ask either. I came away from this experience with an entirely different reference point for how to promote improved hand washing compliance- and it no longer feels fair or responsible to ask this of our patients. The dialogue and ideas being generated are important and worthy of us rethinking our strategy. We have a considerable ways to go before the patient should be helping mistake proof this process. The complexity of developing the safety culture is evident in this dialogue- the role of the patient is invaluable but will require so much more dialogue and meaningful implementation.. I am one of the leaders that is accountable for the metrics on the wall- and wearing the patient gown- I couldn’t speak up.

I agree, practicing excellent hand hygiene is important. I enjoyed your article – I don’t think I could ask a healthcare worker to wash their hands either – unless they were noticeably dirty.

What concerns me is that if you were focused on keeping track of the number of times you washed your hands, could you have had full focus on your patients? That distraction could cost, in manners different from those of poor hand hygiene.

Having a family member that was negatively affected by a distracted physician, I believe this to be an extremely valid concern.

Hi Brianna and thanks for voicing your concern. I do not think I was distracted by keeping track of the number of times I washed or gelled my hands while at work. We would have to examine my work that day and compare it to my “usual” work in order to truly know. But a quick mental addition each time I cleaned my hands hopefully wasn’t enough to take me off task.

But many things need to be considered when we are working on making care safe and patient-centred. Distractions, interruptions, sleep deficits, conflicts with co-workers and much, much more all need to be examined and managed as best as possible.

Hi Dr. Shaw.I really enjoyed your post, I believe this is a problem for most people, I was curious that you actually mentioned that even though you were sure that your kid’s care would not be affected if you ask the doctors and nurses to wash their hands you still felt unconfortable asking same.
I want to share with you my experience, in 2007 I had surgery in a hospital in Edmonton, AB. Because of my backgroung I was very much aware of the risk of going into a hospital for a minor presidure and coming out with a nosocomial infection, something that I did not want. The hospital that I was at is a teaching hospital and therefore the doctors, in their morning rounds, some times had up to 10 medical estudents with them, everybody wanted to see my incision, so I made sure to allow them to see it, but I did not allow them to get close to me or to touch me unless they have wash their hands, I was in a private room and the sink was right in front of my bed therefore there was not excuse, it was surprising how upset they woul get and try to continue on with the visit trying to finishing it as fast as possible. I did feel uncomfortable asking for them to wash their hands but I was determined to not get a life long problem only for their lack of Hygiene. I am thankful that you have made the time to talk about something that is in everybodys mind but never really talk about it. I am happy to say that after 5 days in the hospital I was able to go home and did not contract a disease.

I too have been an emerg patient this summer and for the six hours I was there I only witnessed 1 – yes 1 nurse use Isagel out of the entire treatment team outside of the EMT student wash several times. It happened the MON of ED came by and introduced himself and inquired if I noted the staff hand washing – I was quite honest I had not noticed and even asked where the wash station was.
Even though I have a health care back ground – I was not able to ask any of them to wash their hands.
thanks Dr. Shaw for a great post.

Dr. Susan, I had to go have a little lie-down after reading this post. My overarching reaction was: “If SHE – a medical professional! – cannot bring herself to ask the doctors and nurses to wash their hands, how could I – a dull-witted heart attack survivor and frequent flyer of the health care system – possibly do it?”

The difference between you and me – and all patients! – is that these people are your peers. Yet even you had difficulty bringing yourself to ask (because of your new quasi-patient role as your daughter’s guardian).

That is not the case for the rest of us, where the traditional power hierarchy of medicine is in full force the minute we are rolled through the sliding doors into their turf. No matter how “empowered” we like to believe we are becoming as informed patients, this simple question “Have you washed your hands?” can somehow feel like a threatening confrontation when you’re the one lying there in the flimsy hospital gown. So instead, we slink back to being the meek and well-behaved patient.

I’m reminded of a very effective way that one particular hospital recently managed to get almost universal hand hygiene compliance with one simple tool: a video camera. Long Island’s North Shore University Hospital installed 39 video cameras in their ICU in an effort to increase compliance with hand washing. Hand washing compliance soared from less than 10% to 90% since the program started.

Hi Carolyn! Thanks for the feedback and your ideas and observations. I’m glad you were able to get up after being floored by my story! 🙂

I’ve had it suggested to me that me being a doctor is exactly why I couldn’t speak up. The theory proposed was I would be extra-uncomfortable because the nurses and doctor were my peers and that I might run into them again soon. Maybe, but I don’t think so. Trust me, I don’t let consulting doctors go near my ICU patients without washing or gelling their hands. My inability to speak up was because I was experiencing life as “quasi-patient.”

Thanks for sharing the skepticalscalpel response to the video surveillance of ICU workers at North Shore University Hospital. Very interesting. I’m not sure video surveillance should be the first or only step tried. I’m not sure what it does to the culture of the hospital and team. I would want to make sure all the necessary and appropriate steps have been taken to design in hand hygiene into the work flow, then go from there!

I have noticed a few times when I have gone to the laboratories around Saskatoon to get various blood work done that the lab techs sometimes do not put on any gloves. I think this is a little shocking as they are dealing with people’s blood and if they were to get a needle poke they would not be properly protected as well as ourselves. I often would like to ask them to put on gloves for my protection as well as their protection, but am not sure how to go about doing that.

Thanks for adding in your personal experiences. Wearing gloves when drawing blood is an important part of protecting the worker which makes it even harder for me to understand why we don’t consistently practice excellent hand hygiene each and every time we work with patients.

(Just want to remind everyone that you still need to wash or gel your hands before putting gloves on AND after taking your gloves off!)

I was at a dental appointment. Before starting with me, the hygenist put gloves on, then used her gloved hand to open the lid of a garbage can and throw something in it. She did not use the foot pedal. When I apologetically asked her to change her gloves as she had just used her gloved hand to lift the lid, she insisted that she had not touched the garbage can, that she had used the foot pedal, and had not touched anything. I was extremely uncomfortable as I know there can be bloody gauze or instrumentation thrown in the garbage can. So I stood my ground and said I had seen it, and she begrudgingly rolled her eyes, shook her head and changed her gloves. I had been going to that dentist for 35 years. I faxed the dentist to say I had concerns, and he never called me. I have never gone back.

Great post. What if we make an open written contract between the patient and health care worker. Here it goes. We tell all staff that every patient will get a card that stands up (like ones in conferences where names of the presenters written). On one side it says for the patient, “It is your right to ask your health care provider to wash her/his hands before examination”, on the other side for the health care provider, we write “you provide higher quality health care by washing your hands before examining this patient” or something similar. We will then ask the patients to put these in their room or bed somewhere that all can see. This now becomes a written contract between the patient and the health care provider. We can then test whether an approach like this would change behaviour of either side, resulting in empowered patients and/or mindful healthcare workers.

Interesting idea, Erdem! I like the idea of making an explicit shared agreement between both members of the team – the patient and the healthcare provider. Again, I think it comes down to creating a new norm where healthcare workers clearly give permission to patients to expect and demand hand hygiene be part of care each and every time. This means focusing on the culture, behaviours, and attitudes of us as healthcare providers.

Carolyn Thomas effectively highlights inherent power gap between patients and providers and Dr. Shaw also agrees with it indirectly by saying “…..it comes down to creating a new norm where healthcare workers clearly give permission to patients to expect and demand hand hygiene be part of care each and every time.”

In summary, patients are unable to ask the question because of the inherent power gap between the patient and the provider. On the other hand, it sounds like we need permission from providers to empower patients whose health is at stake.

Lets consider, again, patients’ power to change culture, behaviours and attitudes. Here are some examples;
1) NHS distributed patient’s rights document to every household in order to empower patients and also change the behaviour of the providers.
2) Intel markets its computer chips to the end users in order to affect the behaviour of Intel’s customers which are the computer manufacturers.
3) When we see speed measurement equipment on the road, we cut our speed down, not because there is a police officer, but becase we were provide a written feedback of our actions right at the point.

If we are serious about changing behaivour, culture and attitudes, patients can be empowered effectively by creating explicit expectations which both parties are aware. We need to create enough tension (the possibility that a patient can ask provider to wash his/her hands) without harming the relationship between them (patients actually asking them to wash their hands). We need that quarter to make us take our shopping carts back.

Hi Susan,
Great post! An looks like you struck a chord – given all the feedback/comments!
At my previous employer – Toronto Rehabilitation Institute – the head of research (my previous boss) has been doing a TON of great work on making hand washing the easy thing to do (working it into the work flow). He is a medical engineer and with his team have developed some remarkable tools that can help with the prompting of care providers for hand washing without creating the awkward confrontation between patient and provider that so many have mentioned as a pain point (and reason they don’t ask). They have also developed portable hand wash dispensers that fit on the provider’s clothes/uniform making hand washing easy no matter how far you are from a sink or gel dispenser on a wall. My intention is not to advertise for them…but I think they are making some really useful tools to help with this problem.

I love reading your posts Dr. Shaw. They are so refreshingly “real” and honest. I have worked in healthcare for 14 years and know that culture shift takes a lot more than introducing and promoting best practice. I was always concerned with the direction of educating and promoting the public to ask healthcare staff seemingly innocent but potentially volatile questions like “did you wash your hands’. Without the healthcare staff being on side and supporting this culture shift, we set the public and our staff up for potentially negative encounters. I really liked Steven Lewis’ approach. If I am wearing a button encouraging you to ask me if I washed my hands, it would change my thought process when faced with the question…after all, it is our self talk that we react to, and not the question itself. A little self-awareness can go a long way.

Great insight, Jeanette. Its how we react (or how our patients fear we will react) to the question that needs to be explored and addressed! We really need to focus our efforts and energy on the healthcare workers and system on this one.

I really struggle with having patients and families be the “inspector” for assuring our practices and processes are safe and reliable. As Dr. Don Berwick once noted (inspired by Dr. Deming), “inspection is a surrender to poor quality”.

What can we do to “design in” improved hand hygiene? What is working now? Appreciate thoughts from others….

I’m with you. I do not like the idea of patient as “inspector.” We, as providers, need to work to get it right the first time every time rather than inspecting after the fact for errors. But I do want my patients and families to be partners in providing safe, high quality care that is of greatest value.

As you suggest, we need to design hand hygiene into our daily work flow. In Saskatchewan we are focusing on audits (can’t manage what you don’t measure…) and using Training Within Industry to standardize and improve how we clean our hands. But I believe it will the difficult, never-ending journey of creating a culture of safety for all patients, residents, clients and staff that will get us to where our patients need us to be on hand hygiene.

I cannot tell you the number of times I have been cared for, or my children, and the doctor/nurse/lab technician did not wash their hands. I watch for it closely – it pains me inside to know it and not be able to say anything. I mustered up the courage a few times with lab techs during my pregnancies – two were very nice and quickly offered to change their gloves and another told me the gloves were “for her protection, not mine”! I am a terribly empowered person, but always fear that I might offend the provider, or worse, compromise the relationship (which in my mind would lead to less-than-excellent care).I wonder if the issue isn’t that I am commenting on their personal hygiene, not just “hand hygiene”, and it feels offensive. While I agree that patients must be more empowered to ask, I also wonder if we cannot find another solution (perhaps technological … a periodic alarm that goes off on iPhone with the reminder “doctor, did you wash your hands?”). I don’t know what the solution is, but if self-assured, relatively empowered individuals cannot broach the topic, what is the likelihood of success for the general patient population?

I think you are right that healthcare workers may feel like they are being judged when asked rather than being prompted to do the right thing. Children’s Healthcare of Atlanta is just one hospital system that is using different words in their hand hygiene campaign. “Here, Foam up!” sounds a lot more fun and possible to say than “Please wash your hands.” I have heard that Saskatoon Health Region is switching to a foam alcohol product that works better than our current gel product. Maybe we can add “Foam up!” to our ongoing efforts to improve hand hygiene and patient and staff safety.

I think the problem will not be solved until it becomes easy, natural, and expected that patients ask providers about hand-washing. So we need to devise approaches that will take the anxiety out of it. What if the front of every provider’s uniform or lab coat had a large-font sign that read, “please ask me if I’ve washed my hands before I touch you or your loved one”. It would signal to providers that the organization takes hand hygiene seriously. It suggests to the public and patients that the expected thing is to ask, not to acquiesce in meek silence. In other words, use framing, cues, and the lessons from “Nudge” by Thaler and Sunstein to change behaviour in non-authoritarian, non-threatening ways.

What a great idea, Steven! Hospital workers wearing scrubs printed with “Ask me if I washed my hands” all over them rather than the boring greens I wear in the OR or the holiday-themed or cartoon imprinted scrubs worn by many of our nurses.

And thanks for the reading suggestion – Nudge looks like an interesting read.

Great post, photo and comments! Wouldn’t it be great if public experience re: health care safety and quality culture advanced to the point that other industries and service organizations (restaurants, hotels, etc) wanted to emulate us!

Hi Karen. Thanks for your kind words. And what a great vision of success: other service organizations looking to healthcare to learn how to truly create excellent experiences for the people they serve. If we can imagine it, I’m sure we can figure out a way to make that happen. In the meantime, we should continue to learn from the experts from other industries.

(Have you seen this video? “What if Your Hotel Bill was Like a Hospital Bill” http://www.youtube.com/watch?v=W-u4304UWwU Perhaps not quite as relevant in Canada as it is in the US, but I think we have a long way to go before we can see ourselves as customer service experts!)

I can’t remember which healthcare organization shared with me this idea, but what the organization found was that when they changed the posters, etc. about the importance of hand hygiene from one that focused on the providers needing to do this to one that focused on the benefit to their patients, they had a higher compliance rate for hand hygiene. Perhaps we need visibile messaging in our facilities that says something about the importance of hand hygiene for better care outcomes and how the staff are open to receiving reminders from their patients (clients, residents, etc.).

Great post, thanks Dr. Susan Shaw! I am curious – in that moment when she mentions that she coudn’t do it as she ‘ worried about making the doctor and nurses feel uncomfortable’, if it were us on the receiving end of an inqury to wash our hands, how would we receive that message?

Thanks, Melissa, for your question. I don’t recall ever being asked to wash my hands by a patient or family member. And don’t think even for a second that this is because I’ve practiced perfect hand hygiene every single time during the thousands of encounters I’ve had over almost twenty years of being a medical student, resident, or attending physician.

I would hope I would be gracious (while internally extremely embarrassed) should a family member or patient ask me to wash my hands. When I round with families in the ICU I try to always ask them to watch for us to wash our hands before and after we care for their family member. I do this in front of the entire care team, hoping that this will help give families the words (and strength) to help us keep their loved one safe. But my recent experience makes me realize that this is likely, by itself, insufficient.

We need to make sure that our healthcare workers, regardless of profession, welcome any prompt from a family in a positive way. Any ideas on how to do this would be greatly appreciated!

I really struggle with this. I have yet to work up the nerve to ask a physician or nurse to wash their hands, even though I am hyper aware of whether they have or not. When it’s me receiving care, I can let it go, but when it’s my baby – I end up feeling absolutely awful that I wasn’t able to ask.

I think that care providers should wash their hands in front of the patient immediate prior to the patient interaction. I have seen physicians wash their hands before touching the door handle (a surface covered in germs) upon entering the exam room.

I work in patient safety, and have heard it suggested many times that to increase the use of safety interventions like the Surgical Safety Checklist, we should educate patients and use them as a lever to encourage their surgeon to use a checklist. It’s a nice idea, but we’re so far from it being a reality. If people who “know the business” can’t bring themselves to ask their care providers to wash their hands, how can we expect the average patient to ask the surgeon who is about to cut them open whether they use a Surgical Safety Checklist?

I would love to see my care providers wearing a button/sticker encouraging patients to ask about handwashing. It would be an overt signal that it is, in fact, okay to ask.

It is hard but in spite of my recent experience, I don’t think its impossible to fully bring our patients on to the team. I have been in the OR when a patient asked the team “Are you going to do the checklist?” and the surgeon said “Of course!” But for this to be the norm, we need to change our culture to one where patients are completely comfortable speaking up. We absolutely have to involve and educate our patients and the public but more importantly, we need to change OUR behaviours and attitudes so all patients feel safe speaking up.

One of my favourite ICU nurses worked in Infection Control and Prevention for a few years. One of her early projects was to introduce buttons that said “Ask me if I washed my hands!” Many of us wore them with pride. Not sure where my button has gone but I’m going to see if I can track it down.

I never do this – but I just posted this on my Facebook page. I can’t count the number of times I have worried about hand washing, not just in a medical setting but in restaurants and other places where hygiene is important. Thanks for empowering us to speak up!

Hi Elyse and thanks for sharing this with your friends on Facebook. Please let me know if you get any feedback. And I would love to hear how things go next time you have a hand hygiene worry. I’m going to try to be more brave myself.

Loved your post. Yesterday I was in seeing a specialist – who washed his hands after examining my knee. My immediate reaction was “why are you washing now?” I didn’t say it, but he was washing for his protection, not mine…

Thanks, Colleen, for sharing your own personal experience. You are right – washing our hands after patient contact is to protect ourselves. We need to clean our hands before we interact with our patients each and every time. And we need to do it in front of our patients so they can be confident that it was done.

At my doctor’s office for a flu shot, I was ushered into a small side room to wait. It was filthy and chaotic. There was literally mud on the floor, and cascades of medical supplies tumbling out of cabinets onto the mud. I was horrified and when I moved on to my appointment, I apologized, but said I felt I just had to bring up the condition of the room I’d been in. The doctor wouldn’t meet my eye; she just said sometimes they didn’t have time to tidy away deliveries. Now, whenever I am in the clinic, I am convinced it is seething with germs. I’ve started watching for handwashing, too. If they can’t get around to sweeping and picking up spilled supplies, what are the odds they clean any thing else?

Loved this post — it illustrates how difficult it is to confront a situation, even for those who are knowledgeable. I believe that sharing these stories and raising awareness helps us all be more pro-active. Thank you.

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